What’s the best advice that one HHS secretary can give to another? Tommy Thompson — who ran the department for four years under President George W. Bush — says his guidance to new leader Alex Azar has been clear: Never hesitate.

Azar assumed leadership of HHS in February after a tumultuous year when predecessor Tom Price resigned after a charter jet plane scandal. As a young lawyer, Azar got his start in health care 17 years ago when Thompson reached out and asked him to serve as his HHS general counsel. The two men have been close since; Thompson introduced Azar at his Senate confirmation hearing earlier this year.

Thompson said that he’s told Azar that the HHS secretary needs to be decisive while juggling daily emergencies and administration priorities.

“The worst thing in a department that large is to try and delay the decision-making … It doesn’t get any easier,” Thompson added. “It will kill you and it will break down the flow in the department if you, the secretary, cannot make decisions.”

But quick decisions as HHS secretary don't always translate into fast results, Thompson added, saying that the “slow, laborious process” of policymaking requires patience and politicking. For instance, Thompson said he had to learn how to win over “the 75,000, 80,000 employees [who] all think they’re smarter than the secretary.” He also bemoaned the role of the White House and the junior staff who could hold up a proposal in clearance or kill it altogether.

“OMB, they turn you down four times out of five just to show you who the boss is,” Thompson said.

Thompson sees several bold decisions awaiting his former protégé. “The biggest decision is how do you get drugs to market faster,” Thompson said, praising FDA Commissioner Scott Gottlieb — another one of his former staffers — while arguing there’s much more to do. For instance, Thompson argued to slim down the FDA’s Phase 3 review and move drugs to market quicker, where FDA could institute a formal “Phase 4” process that involves formal post-market surveillance.

Thompson also praised another dramatic action by the Trump administration: Its push to add work requirements to Medicaid.

“I’m all for it. It’s what I started back in Wisconsin when I was governor, and it worked,” Thompson said, referencing his welfare work requirements that became a model for the Clinton administration’s national welfare reform. “People should work. People should not get a handout,” Thompson added.

Thompson acknowledged that there are differences between Medicaid — as a health coverage program — and welfare. But “there are a lot of people on Medicaid who can work,” he said. Democrats generally oppose adding such requirements to a health program.

In his post-government career, Thompson said he’s involved in about 30 companies, with a special focus on cancer. “One of my new missions in life is to come up with medicines,” he said, pointing to his new position as a board member for a firm called Tyme that’s working on pancreatic cancer treatments. “I want to make sure that health care companies get a chance.”